Effect of Health Education Technology on Nutritional Literacy and Anemia in Pregnant Women

Authors
E. Sulpat 1
E. Yunitasari 2
I. Krisnana 1
F.D. Marsinta 2
A. Mardhika 2
L. Fadliyah 3
A.P.M. Tyas 2
S. Harianto 1
1 Faculty of Nursing, Airlangga University, Surabaya, Indonesia
2 Faculty of Vocational Studies, Airlangga University, Surabaya, Indonesia
3 Faculty of Medicine, Airlangga University, Surabaya, Indonesia
10.58209/hehp.13.2.241
Abstract
Aims: This study aimed to analyze the effect of implementing health education technology on improving nutritional literacy and preventing anemia in pregnant women, as well as to identify the most effective technological approaches to support maternal and fetal health.

Materials & Methods: This cross-sectional quantitative study was conducted at Balerejo Health Center in Madiun Regency, involving 132 pregnant women as participants. Data were collected through questionnaires, in-depth interviews, and medical records. Statistical analysis was performed using Smart-PLS to test the reliability of the instrument and to assess the relationships between parameters. Four technological interventions, including mobile applications, e-learning, social media, and telemedicine were evaluated.

Findings: All technologies had a significant effect on improving nutritional literacy and preventing anemia. Telemedicine had the largest effect (T=2.861; p=0.004) due to direct interaction with health workers. The R² value was close to 1.000, indicating that technology explained most of the variation in the results. Although 84.1% of respondents were of ideal age (20-35 years) and 59.1% had adequate income, 40.9% of pregnant women still experienced anemia, emphasizing the importance of nutritional education.

Conclusion: The implementation of health education technology, especially telemedicine, is effective in increasing nutritional literacy and reducing the risk of anemia in pregnant women.

Keywords

Subjects

Introduction
In the last few decades, the application of technology in various sectors has significantly improved people’s quality of life [1]. One sector experiencing rapid development is the health sector, including health education, which aims to increase nutritional literacy and prevent various health problems, especially in vulnerable groups such as pregnant women [2]. Anemia in expectant women remains a public health issue in numerous countries, including Indonesia [3]. This condition has the potential to negatively impact the health of both the mother and the fetus, as well as to elevate the likelihood of complications during pregnancy and labor [4].
Anemia in expectant women is a condition characterized by hemoglobin levels in the blood that are below the normal range. This condition is typically caused by iron deficiency [5]. Data from the Indonesian Ministry of Health indicate that anemia remains a significant cause of mortality for both mothers and neonates, with a high prevalence among pregnant women [6]. A variety of complications, such as premature birth, low birth weight, and impaired fetal growth and development, can result from anemia. Consequently, it is crucial to implement efforts to prevent anemia in order to enhance the health of both mothers and infants [7]. A lack of nutritional literacy, specifically a lack of understanding of the significance of adequate nutritional intake during pregnancy, is one of the primary factors contributing to the high prevalence of anemia among pregnant women [8]. Many expectant women are unaware of the importance of consuming recommended iron supplements during pregnancy, the methods to enhance iron absorption, and the food sources that are rich in iron [9]. Additionally, expectant women’s food consumption patterns are adversely affected by social, economic, and cultural factors, which result in inadequate nutritional intake.
The development of digital technology has brought significant changes in how people obtain information, including in the health sector [10]. Digital-based health education technology, such as mobile applications, e-learning, telemedicine, and social media, can provide innovative solutions to increase the nutritional literacy of pregnant women [11]. The application of technology in health education allows for the delivery of information that is more accessible, interactive, and based on scientific evidence, which can enhance the understanding and awareness of pregnant women regarding the importance of balanced nutrition and the prevention of anemia [12]. Using technology in health education can increase the effectiveness of counseling compared to conventional methods [13]. Digital technology enables pregnant women to access real-time information, and educational materials anytime and anywhere, and to interact directly with health workers through online platforms [14]. Furthermore, the use of applications and social media can also increase the involvement of pregnant women in health education programs, thereby accelerating changes in healthier behaviors [15].
Several technological innovations that can be used in health education for pregnant women include mobile applications for nutrition education, e-learning and webinars, social media, digital content, telemedicine, and online consultations [16]. Health mobile applications can provide information regarding nutritional needs during pregnancy, healthy food menus, and reminders to consume iron supplements [17]. E-learning and webinars allow pregnant women to participate in online training programs involving professional health workers who provide education about nutrition and anemia prevention [18]. Utilizing social media platforms, such as Instagram, YouTube, and TikTok is also an effective way to disseminate health information through educational videos, infographics, and interactive articles [19]. Meanwhile, telemedicine services and online consultations enable pregnant women to communicate directly with doctors or nutritionists to receive personalized recommendations regarding diet and nutritional supplements needed during pregnancy [20].
With these various technological innovations, pregnant women can obtain health information more easily and effectively [21]. However, the success of implementing technology in health education depends on factors such as technology accessibility, the level of digital literacy among pregnant women, and support from health workers and the government in developing and promoting the technology [22]. Although technology has great potential to increase nutritional literacy and prevent anemia in pregnant women, several challenges must be considered in its implementation. Some of these challenges include limited accessibility and infrastructure, especially in rural or remote areas, and low digital literacy among pregnant women who are not yet accustomed to using digital technology [23]. Additionally, the accuracy of information is an important concern, as disseminating unverified health information through digital media can be misleading. Therefore, it is crucial to ensure that the educational content is based on scientific evidence and supervised by health professionals. The involvement of health workers is also essential in providing assistance and ensuring that pregnant women understand and correctly apply the information obtained [24].
The objective of this research was to investigate the impact of health education technology on the prevention of anemia and the enhancement of nutritional literacy in expectant women. Additionally, this study aimed to identify the most effective approach for utilizing health education technology to provide health education to expectant women, thereby improving the well-being of both the mother and her unborn child. Furthermore, the findings of this investigation may serve as a foundation for the development of more sustainable and effective technology-based education programs and policies by health agencies and the government. Therefore, the integration of technology into health education has the potential to enhance the quality of maternal and infant health by reducing anemia rates in pregnant women. The application of technology in health education holds great promise for increasing nutritional literacy and preventing anemia in pregnant women. By utilizing various digital platforms such as mobile applications, e-learning, social media, and telemedicine, pregnant women can access health information that is easier to obtain and understand. However, to ensure its effectiveness, a comprehensive approach is needed that considers existing challenges, including accessibility, digital literacy, the accuracy of information, and the involvement of health workers. Consequently, this research represented an important step in identifying the best strategies to optimize the use of health education technology to improve the overall health of mothers and babies.

Materials and Methods
Research type and setting
This cross-sectional quantitative research was conducted at the Balerejo Community Health Center in Madiun Regency, which is one of the Community Health Centers with nutritional support and monitoring facilities for pregnant women from June to December 2024. The Balerejo Community Health Center was chosen as the research location because it serves a large number of pregnant women and offers healthy lifestyle programs that can be subjects of research. This timeframe was selected to ensure that the data collected covered all aspects of the research objectives.
In quantitative research, the primary goal is to study a specific population or sample using structured research instruments. The data obtained were statistically analyzed to test the established hypotheses. The statistical method employed was partial least squares structural equation modeling (PLS-SEM). The selection of this method aligned with the purpose of predictive research and involved several latent constructs, such as mobile applications, e-learning, social media, and telemedicine, in relation to nutritional literacy and anemia prevention in pregnant women. The use of PLS-SEM can be observed through the reliability testing of constructs using composite reliability and Cronbach’s alpha values, as well as hypothesis testing utilizing t-statistical values, p-values, and bootstrapping techniques. One of the main advantages of PLS-SEM is that there is no need to assume data normality, allowing this method to be used even if the data distribution is abnormal.
Population and sample
The research employed a total population sampling technique. All pregnant women undergoing pregnancy checks at the Balerejo Health Center (a total of 132 pregnant women) were included as the sample.
To avoid selection bias, participants were randomly divided using Random Allocation Software into two groups, including the intervention group (Pregnant women with multiple pregnancies) and the control group (Pregnant women with pregnancy disorders, such as preeclampsia, hypertension, and gestational diabetes)
Data collection techniques
Primary data
Primary data were obtained through questionnaires and interviews. The questionnaire employed an ordinal scale to assess pregnant women’s perceptions and experiences regarding nutritional literacy and anemia prevention. In-depth interviews explored food consumption, awareness of the importance of iron, and the effectiveness of health education technology.
Secondary data
Secondary data were taken from the patients’ medical records at the relevant healthcare facility and included Health conditions of pregnant women, hemoglobin levels, history of pregnancy, and risk factors for anemia.
Data processing and analysis
Data were managed using SmartPLS with processes, including editing, coding, tabulation, and grading. The analysis was carried out using regression analysis to test the relationship between parameters and a Likert scale (one=strongly disagree to five=strongly agree) for the assessment of the questionnaire.

Findings
Most of the pregnant women were of ideal age for pregnancy, had a high level of secondary education, and were in good nutritional condition. The interval between pregnancies was generally more than two years, and most of the participants had only one or two previous pregnancies. From an economic perspective, more than half of the respondents had a fairly good income, which likely helped them maintain their nutritional intake during pregnancy. This situation can support their health and that of the fetus they were carrying. Nevertheless, despite many mothers being in supportive conditions, there were still quite a few cases of anemia. This indicated that the health of pregnant women was influenced not only by age or income but also by their understanding of nutritional needs during pregnancy. These findings reinforce the importance of counseling and education about nutrition so that pregnant women can take better care of their health (Table 1).

Table 1. Frequency of respondents’ characteristics at the Balerejo Community Health Center, Madiun Regency, in 2024


Most of the aspects studied exhibited a good level of consistency. Mobile applications and telemedicine services appeared to be more stable and reliable compared to e-learning and social media in delivering health education. This is evident from the strength and uniformity of the responses provided by the participants. Although there was a slight difference in the degree of acceptance for each approach, the tools used to assess the experiences of pregnant women were generally considered quite trustworthy. One approach demonstrated the best and most consistent results throughout the measurement, reflecting that the method was well understood and accepted by the users (Table 2 and Figure 1).

Table 2. Composite reliability and Cronbach’s alpha inspection results



Figure 1. Regression Results on the effect of implementing health education technology on increasing nutritional literacy and preventing anemia in pregnant women.

The use of health education technology had a significant impact on helping pregnant women understand the importance of nutrition and prevent anemia. The digital tools and methods employed were capable of addressing almost all aspects related to improving nutritional understanding. Not only was this approach effective, but it was also consistent and remains robust even when applied in various conditions. These findings reinforce the belief that technology-based education can be an effective solution for improving the health of pregnant women, particularly concerning nutritional literacy and anemia prevention.
To ensure that the results are trustworthy and accurately reflect the conditions in the field, a process of repeated testing was conducted on the data collected. In this process, the data were thoroughly analyzed to assess the reliability of the relationship found between the use of health education technology and changes in pregnant women’s understanding and behavior.
The approach used allowed the researcher to assess whether the results that emerged were not just coincidences but reflected a real pattern. If the results of this test showed high consistency, it could be concluded that the findings were quite strong and could serve as a basis for decision-making or the development of similar programs in the future.
The use of technology in health counseling had a strong and tangible impact on improving nutritional understanding and preventing anemia in pregnant women (Figure 1 and Table 3). Some of the approaches utilized included mobile applications, online learning, social media, and remote health services.


Figure 2. Bootstrapping output.

Table 3. The examination results based on the indicators used
 

Among the four approaches, remote health services (telemedicine) had the greatest influence, as they were capable of providing direct consultation and education even without face-to-face interaction. Mobile apps, social media, and e-learning were significantly helpful, although E-learning was slightly less effective than the other approaches.
Thus, the comprehensive use of technology, particularly those that are interactive and easily accessible, was a very effective strategy for increasing the knowledge of pregnant women and encouraging healthy living behaviors.

Discussion
This study aimed to analyze the effect of implementing health education technology on improving nutritional literacy and preventing anemia in pregnant women. The mobile app provided important insights into how technology can be applied in efforts to prevent health problems that are often overlooked, such as anemia in pregnant women, which is a global issue. In this context, mobile applications not only serve as a means of disseminating information but also as a practical and efficient educational tool.
One of the key contributions of these findings is the app’s ability to improve nutritional literacy among pregnant women. Enhanced nutritional literacy enables pregnant women to understand their nutritional needs during pregnancy and, consequently, can help prevent conditions such as anemia. Additionally, the app can provide personalized recommendations, allowing pregnant women to adjust their nutritional intake based on their individual health conditions. This is especially important because the prevention of anemia relies on an individual’s understanding of their nutritional needs, which is often poorly comprehended.
Furthermore, the active involvement of pregnant women in using mobile applications demonstrated that technology can be a valuable information bridge, particularly in areas with limited access to health facilities. With the app, pregnant women could obtain accurate information about nutrition and anemia, even when they could not access health facilities directly. This is particularly relevant considering the limited resources in some areas that may hinder pregnant women from obtaining adequate nutritional information.
These findings align with previous research, demonstrating that using mobile applications in health education can enhance users’ understanding and awareness of health information. Chaudhary et al. [25] found that mobile-based applications designed for nutrition education increase the involvement and understanding of pregnant women in managing their nutritional intake. Additionally, Boynito et al. [26] reveal that using health applications positively impacts awareness about anemia prevention through interactive features and reminders for iron supplement consumption. However, the results of this study also indicate that the influence of mobile applications is not as significant as some other variables, such as telemedicine. This may be due to limited accessibility, the low digital skills of some pregnant women, or a lack of direct interaction in the applications used.
E-learning could make a positive contribution to equipping pregnant women with the necessary knowledge to understand the importance of nutrition during pregnancy. This indicates that the use of digital technology, although not the most dominant compared to other parameters, such as telemedicine, still has a significant impact on behavioral changes and health awareness.
The use of e-learning offers flexibility in delivering educational materials that can be accessed anytime and anywhere, making it an inclusive tool, especially for pregnant women who have limitations in accessing health services directly. Furthermore, the success of this approach demonstrates that digital learning media can bridge geographical and socio-economic limitations that often pose obstacles in conventional health education programs.
Hoque et al. [27] found that e-learning-based educational programs significantly improve participants’ understanding of nutrition and maternal health compared to conventional methods. This is because e-learning provides access to information that is more flexible, interactive, and can be tailored to individual needs. Additionally, Murthy et al. [28] showed that pregnant women who participate in online-based educational programs are more likely to adopt a healthy diet than those who rely solely on regular medical consultations.
With its interactive characteristics, ease of access, and ability to reach a wide audience in a short time, social media can effectively address the challenge of disseminating nutritional information, particularly for pregnant women. In this context, social media not only functions as a one-way communication channel but also serves as a discussion space that facilitates dynamic knowledge exchange between pregnant women and health workers or nutritionists.
User involvement in online communities is also one of the strengths of social media in promoting healthy behaviors. Active participation in health forums or groups encourages pregnant women to be more mindful of their body condition and nutritional needs. This indicates that social media can create a collaborative and supportive learning environment, which is often not achieved through conventional educational methods.
Furthermore, the effectiveness of social media in improving nutritional literacy underscored the importance of adapting health promotion strategies to technological developments and people’s behaviors. In the digital age, social media-based approaches have the potential to expand the reach of public health interventions at a relatively low cost while achieving a wide impact. Therefore, social media can be an important component in designing a more comprehensive and sustainable anemia prevention program.
This finding aligns with research conducted by Ghorbani-Dehbalaei et al. [29], who found that social media plays a crucial role in increasing pregnant women’s awareness of maternal health. They noted that pregnant women often use platforms, such as Facebook, Instagram, and YouTube to seek information on healthy eating patterns and the risks of anemia. In their study, pregnant women actively accessing health content on social media, demonstrate a greater increase in understanding compared to those who only rely on routine medical consultations.
Telemedicine emerged as the most powerful approach in supporting the improvement of nutritional literacy and anemia prevention in pregnant women compared to other digital education methods. Its advantage lies in its ability to provide direct and personalized health consultation services, allowing pregnant women to gain a more specific and relevant understanding of their health conditions. Real-time interaction between healthcare workers and patients offers a more in-depth and responsive educational dimension, which cannot always be achieved through social media or e-learning platforms.
Additionally, telemedicine greatly contributes to overcoming geographical and accessibility barriers, especially for pregnant women who live in remote areas or have mobility limitations. This positions telemedicine as a strategic solution for equitable access to information and health services while supporting promotive and preventive efforts in the context of maternal health. Its significant effectiveness also suggests that this technology-based approach is worth considering in the formulation of public health policies and interventions, particularly those focused on vulnerable groups such as pregnant women.
This finding is consistent with previous studies highlighting the effectiveness of telemedicine in maternal health education. Bhattarai et al. [30] found that telemedicine increases access to maternal health services and significantly enhances pregnant women’s understanding of balanced nutrition. They discovered that pregnant women who use telemedicine are more likely to follow healthy diet recommendations than those who only rely on social media or e-learning-based education.
Based on the results discussed in the study, several limitations should be noted. First, while the use of digital technology, including mobile applications, e-learning, social media, and telemedicine, has a positive impact on increasing nutritional literacy and preventing anemia in pregnant women, the effectiveness of each method is uneven. For instance, limited access to technological devices and internet connectivity in certain areas, along with low digital skills among some pregnant women, poses obstacles to utilizing online learning applications and media. Second, the lack of direct interaction on various digital platforms, such as applications and e-learning, restricts the process of clarifying information or engaging in in-depth discussions, which may lead to suboptimal understanding. Third, this study has not thoroughly explored the socio-cultural factors that can influence the acceptance and effectiveness of digital technology among pregnant women, such as social norms, family support, or education level.
Based on these limitations, the following suggestions can be made. First, there should be a strategy to enhance digital literacy among pregnant women, particularly in areas with limited access, through simple training or community-based mentoring. Second, integrating technological approaches with human-based interventions—such as combining applications with visits from health workers or community health cadres—can improve the effectiveness of learning. Third, the development of digital applications and platforms should prioritize higher interactivity and personalization to address the specific needs of users. Fourth, further studies are necessary to investigate the role of social, cultural, and economic factors in determining the success of digital technology in maternal health education. Finally, it is recommended that the government and policymakers support initiatives that promote the use of community-based health technology as part of a more inclusive and sustainable national anemia prevention strategy.

Conclusion
The use of health education technology is effective and significant in improving nutritional literacy and preventing anemia in pregnant women, with telemedicine demonstrating the strongest influence.

Acknowledgments: We would like to express our deepest gratitude to the dean, head of the department, and head of the study program at the Faculty of Vocational Studies, Airlangga University, for their outstanding support throughout the research process. We also extend our highest appreciation to the head of the Balerejo Community Health Center, Madiun Regency, East Java, for allowing us to conduct research at their facility. Finally, we thank the respondents who took the time to participate in our study.
Ethical Permissions: This research received ethical approval from the Research Ethics Committee of Universitas Muhammadiyah Gresik, under Number: 026/KET/II.3.UMG/KEP/A/2024 dated 23 April 2024. Additionally, respondents signed an informed consent form
Conflicts of Interests: The authors reported no conflicts of interests.
Authors' Contribution: Sulpat E (First Author), Introduction Writer/Main Researcher (12.5%); Yunitasari E (Second Author), Methodologist/Assistant Researcher (12.5%%); Krisnana I (Third Author), Methodologist/Main or Assistant Researcher/Discussion Writer/Statistical Analyst (12.5%); Marsinta FD (Fourth Author), Assistant Researcher (12.5%); Mardhika A (Fifth Author), Assistant Researcher (12.5%); Fadliyah L (Sixth Author), Discussion Writer (12.5%); Tyas APM (Seventh Author), Discussion Writer (12.5%); Susilo Harianto S (Eighth Author), Statistical Analyst (12.5%)
Funding/Support: This research was supported by the Faculty of Nursing, Airlangga University, Surabaya, Indonesia.
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Health Education and Health Promotion
Volume 13, Issue 2
Spring 2025
Pages 241-248